Provider Demographics
NPI:1619139219
Name:SENIOR NETWORK HEALTH, LLC
Entity Type:Organization
Organization Name:SENIOR NETWORK HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAREK-LAQUAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-624-4555
Mailing Address - Street 1:2521 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5825
Mailing Address - Country:US
Mailing Address - Phone:315-624-4565
Mailing Address - Fax:315-624-4541
Practice Address - Street 1:2521 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5825
Practice Address - Country:US
Practice Address - Phone:315-624-4565
Practice Address - Fax:315-624-4541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAWK VALLEY NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01778523305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01778523Medicaid